## Facts

- Ashley A. Diamond, a transgender woman diagnosed with gender dysphoria, entered Georgia prison custody after a probation violation and had received hormone therapy for about 17 years before incarceration.
- The Georgia Department of Corrections housed her in closed- or maximum-security men’s facilities despite her nonviolent status and alleged vulnerability as an openly transgender woman.
- Diamond alleged officials terminated her hormone therapy under a department policy governing transgender prisoners that limited treatment based on intake status and “maintenance” care rather than individualized medical assessment.
- She alleged severe deterioration from denied treatment, including extreme distress, suicide attempts, and attempted self-castration, and that her body began reverting to a more masculine appearance.
- Diamond alleged repeated rapes and other sexual assaults by other inmates, including a cellmate, and that she repeatedly sought safer housing or transfer.
- A mental-health professional recommended moving Diamond to a medium-security facility, but she alleged officials transferred her instead to another closed/maximum-security men’s prison where additional assaults occurred.
- Diamond alleged some officials mocked her gender identity, blamed her for assaults, and responded dismissively to her safety concerns.
- Diamond sued multiple corrections officials, asserting Eighth Amendment claims for deliberate indifference to serious medical needs and deliberate indifference to a substantial risk of serious harm.
- Defendants moved to dismiss under Rule 12(b)(6) and asserted qualified immunity.

## Issues

1. Whether the complaint plausibly alleged deliberate indifference to a serious medical need under the Eighth Amendment based on denial of appropriate treatment for gender dysphoria pursuant to a blanket policy.
2. Whether the complaint plausibly alleged an Eighth Amendment failure-to-protect claim based on officials’ alleged awareness of and disregard for a substantial risk of sexual assault.
3. Whether defendants were entitled to qualified immunity at the pleading stage on the Eighth Amendment claims.

## Decision

- The court denied the motions to dismiss.
- The court held that, taking the allegations as true, Diamond plausibly stated an Eighth Amendment claim for deliberate indifference to serious medical needs arising from denial of treatment for gender dysphoria.
- The court held that Diamond plausibly stated an Eighth Amendment failure-to-protect claim based on alleged knowledge of her risk of sexual assault and inadequate protective action.
- The court denied qualified immunity at the motion-to-dismiss stage because the alleged conduct implicated clearly established Eighth Amendment rights.

## Legal Principles

- Prison officials violate the Eighth Amendment when they are deliberately indifferent to a prisoner’s serious medical needs; the condition’s seriousness and the adequacy of treatment are evaluated under established deliberate-indifference standards.
- Gender dysphoria can constitute a serious medical need; allegations that treatment was denied or curtailed under a categorical policy, rather than individualized medical judgment, can support an Eighth Amendment claim at the pleading stage.
- Prison officials violate the Eighth Amendment when they know of and disregard an excessive risk to inmate safety, including a substantial risk of sexual assault; repeated reports, obvious vulnerability, and prior assaults can support an inference of subjective awareness.
- Qualified immunity is unavailable at the pleading stage when the complaint plausibly alleges constitutional violations and the relevant rights were clearly established, including the prohibitions on deliberate indifference to serious medical needs and known risks of serious harm.

## Conclusion

The court allowed Diamond’s Eighth Amendment medical-care and failure-to-protect claims to proceed, holding that the alleged denial of individualized treatment for gender dysphoria and the alleged disregard of a known, substantial risk of sexual assault plausibly stated constitutional violations and defeated qualified immunity at the dismissal stage.


Diamond v. Owens, 131 F. Supp. 3d 1346 (M.D. Ga. 2015)